Visit our website at: massgeneral.org/neuroendocrine Sellar Masses Are Not Always Pituitary Adenomas – What Are the Diagnostic Possibilities?

Most, but not all, sellar abnormalities are pituitary adenomas.We recently reviewed our series of transsphenoidal proce-dures done between 1998 and 2009 to determine the inci-dence and characteristics of non-pituitary sellar lesions (1). Over this period, 1,469 transsphenoidal procedures were performed. One hundred sixteen cases (7.9%) were not pituitary tumors. These were divided into four major pathologic groups, including cystic lesions (53%), benign neoplasms (22%), malignancies (16%) and inflamma-tory lesions (9%). The most common lesions were Rathke’s cleft cysts, which comprised 42 % of the series. The most common pre-senting symptoms were visual field abnormalities (51%) and headache (34%). Endocrine abnormalities were present in 58 % of cases, most commonly hyperprolactinemia (35%), hypogonadism (23%), and hypocortisolism (23%). Presenting symptoms typically improved postoperatively, with resolution of headache in 63%, and resolution of visual symptoms in 65%. Case History. A 37 year old female presented with six weeks of pro